Daily News

Jung-Min Ahn, MD
Asan Medical Center, Republic of Korea TAVR Technique in Bicuspid Anatomy, Jung-Min Ahn, MD (Asan Medical Center,Korea) stressed not to do oversizing in bicuspid aortic valves (BAV) patients using the self-expandable valves (SEV).

“For BAV trans-catheter aortic valve replacement (TAVR), undersizing is safe and effective when considering calcification and annulus shape.” Ahn said. Jung-Min Ahn explained how to determine sizing in BAV TAVR according to the amount of calcification and its risk of rupture at the 28th TCTAP 2023 on May 7.

In the previous STS/ACC TVT Registry, using Sapien 3 valve, BAVs and tricuspid aortic valves (TAVs) were not found to be different in terms of 1-year mortality or stroke, and Evolut R had no different outcomes for all-cause mortality. Recent registry data comparing the Sapien XT and CoreValve devices showed no difference in all-cause mortality after 2 years of follow-up. Additionally, the BEAT registry found no difference in mortality between the Sapien 3 and Evolut R devices, but the former was associated with a higher risk of annulus rupture, while the latter was associated with significant paravalvular leakage (PVL).

Dr. Ahn pointed to the BAVARD registry (Figure 1). It was found that about 90% of BAVs were of the tubular or flare type, which required annulus sizing without consideration above the annulus. Severe aortic valve calcifications, such as severe asymmetric calcification, calcified raphe, and left ventricular outflow tract (LVOT) calcification, are also associated with higher procedural risk and long-term mortality, and the optimal device sizing should be adjusted for the calcification volume.

Figure 1.Sizing of BAV TAVR by the BABARD registry

According to Dr. Ahn, undersizing rather than oversizing is safe and effective in treating bicuspid aortic stenosis. He cited their Sapien 3 registry findings, which showed that compared to TAVs with 110% oversizing, BAVs required only about 105% oversizing during TAVR (Figure 2).